A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye) [In advanced stages, the following symptom may occur: Icterus (jaundice)]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Inspection and palpation (palpation) of the lymph node stations (cervical, axillary, supraclavicular, inguinal); lymph node involvement of the Virchow’s gland (= supraclavicular lymph node station left) (absolute rarity).
- Inspection and palpation of the spine.
- Auscultation (listening) of the heart
- Auscultation of the lungs
- Examination of the abdomen (belly)
- Percussion of the abdomen/examination of the abdominal cavity by tapping the abdominal wall with the fingers [ascites (abdominal fluid); hepatomegaly (enlargement of the liver)]
- [Ascites: Fluctuation wave phenomenon. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly and/or splenomegaly: estimating liver and spleen size]]
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [In advanced stages, the following symptoms may occur:
- Ascites
- Hepatomegaly
- Palpable resistance in the upper abdomen]
- Percussion of the abdomen/examination of the abdominal cavity by tapping the abdominal wall with the fingers [ascites (abdominal fluid); hepatomegaly (enlargement of the liver)]
- Inspection (viewing).
- Gynecologic examination [to exclude ovarian drip metastases (metastases (daughter tumors) arising in body cavities (in this case, abdomen/pelvic cavity) by caudal migration (toward the lower end of the body) of detached tumor cells with gravity on other organs or organ parts (in this case, ovaries/ovaries))/(Kruckenberg tumor)]
- Health check (as an additional follow-up measure).
Square brackets [ ] indicate possible pathological (pathological) physical findings.